Methadone Harder to Obtain Than Heroin, Addicts Report

February 1997

Recovering heroin addicts are reporting that their efforts to get methadone,
a medication used to treat opiate addiction, are hindered by the federal
government's ban against prescribing the drug, by state prohibitions, and
by a shortage of treatment slots. It is more difficult for recovering addicts
to obtain methadone than the heroin that they are trying to resist (Christopher S.
Wren, "Ex-Addicts Find Methadone More Elusive Than Heroin," New
York Times, February 2, 1997, p. A12).

Methadone, a synthetic narcotic that does not produce a high at therapeutic
dosage levels, is a Schedule II drug (considered to have a high potential
for abuse but with an accepted medical use). Patients usually take it daily
for long periods of time for successful treatment. The country's most tightly
controlled legal drug, methadone is only available at specially licensed
clinics, which are "run by a bureaucracy" and "difficult
to access," according to Dr. Henry Blansfield, a retired surgeon
who has treated substance abuse for 20 years. In addition to a narcotics
license, clinics are required to have as many as three methadone licenses --
one each at the federal, state, and county level, according to Joycelyn
Wood, executive vice president of the National Alliance of Methadone Advocates
(NAMA), in an interview with NewsBriefs.

Eight states -- Idaho, Mississippi, Montana, North Dakota, South
Dakota, West Virginia, Vermont and New Hampshire -- do not allow methadone
clinics. Because of this, it is not uncommon for patients in those states
to drive several hours round trip every day to receive their methadone treatment
out of state. Omere Luneau, a New Hampshire carpenter, drives four hours
every day to Massachusetts for his treatment, at a cost of about $625 a
month, including gas. Often, recovering heroin addicts, who hold jobs and
are responsible parents, suffer from withdrawal if they miss their methadone
dose due to common frustrations such as bad weather, family emergencies
and traffic congestion.

Methadone is almost never dispensed by prescription. Alice Randolph-Diorio
of Vermont, who has undergone 26 surgeries related to problems with her
pelvis and spine, is one of the exceptions. She is a recovering heroin addict
who used to drive three hours to get methadone until a doctor convinced
health officials to allow her to have a prescription. Wood told NewsBriefs
that Randolph-Diorio's doctor circumvents the federal ban by prescribing
methadone for her pain, not for her addiction recovery. "It's frightening
to think that the only way for a person to get methadone here is to suffer
from chronic pain," said Randolph-Diorio.

Other exceptions exist. Woods told NewsBriefs that the FDA has
already exempted about a dozen patients who live long distances from clinics,
but that patients must find a doctor willing to fill out the extensive paperwork.
Dr. Edwin Salsitz runs a methadone clinic in New York City at Beth Israel
Hospital that operates as a "special research project." About
1,000 long-term, stable patients receive prescribed methadone under Salsitz's
care, according to Wood.

"A methadone patient is monitored more closely than a paroled murderer,"
said Salsitz. This monitoring exists because methadone "can cause very
serious damage to public health and public safety" and is "causing
so many deaths and arrests," claims Terence Woodworth, deputy director
of the DEA's Office of Diversion Control. However, a 1995 study by the Institute
of Medicine, a branch of the National Academy of Sciences, found tht methadone
caused only "minimal medical harm." Furthermore, the study said,
"The number of cases in which methadone has been documented as the
sole direct cause of death is very small." (Richard A. Rettig and Adam
Yarmolinsky (eds.), "Federal Regulation of Methadone Treatment,"
Washington, D.C.: National Academy Press, 1995.)

Woodworth said stringent controls were mandated by Congress in 1974 to
prevent diversion of the drug. The DEA argues that letting addicts take
methadone home might lead addicts to sell it in order to buy street drugs.
Methadone patients admit that some diversion exists, though usually to other
addicts who cannot get into treatment programs. There are an estimated 600,000
heroin addicts in the United States, and only 115,000 treatment slots. "If
I wanted to get high, I'd buy heroin," said Wood. She said only addicts
looking to stabilize their lives would buy illegal methadone. David Lewis,
M.D., the director of Brown University's Center for Alcohol and Addiction
Studies, confirmed Wood's contention that methadone is not a popular street
drug.

Woods told NewsBriefs that federal regulations are currently being
rewritten to allow reliable patients to leave clinics and seek methadone
maintenance under a physician's care. Woodworth said the DEA would endorse
such a change because "it minimizes diversion." Woods added that
four states -- New Hampshire, Vermont, Connecticut and California --
have recently moved to allow for prescribed methadone. Still, a doctor's
prescription is not easy to get because addicts are often stigmatized by
doctors as "junkies," according to Wood. She recommends building
a relationship with a doctor before asking about methadone maintenance.
She said stigmatization of recovering addicts by society is still the greatest
obstacle for those seeking methadone treatment.